What is an evidence-based technique?

Chapters

• 0:08 Podcast Introduction and Rebranding
• 2:17 Understanding Evidence-Based Practice
• 7:22 Navigating Clinical Uncertainty
• 10:43 The Problem with Evidence-Based Techniques
• 18:05 Finding Common Ground in Manual Therapy
• 25:31 Moving Forward as a Profession

Transcript

Eric: 0:08

Hello and welcome to the Massage Science Podcast. My name is Eric Purves. I'm an RMT course creator, continuing education provider and advocate for evidence-based massage therapy. So thank you for being here and I hope you enjoy this episode. So thank you for being here and I hope you enjoy this episode.

Eric: 0:25

I realized that it has been four months since I last released a new podcast. I was doing really well with these for a while and for a couple years there I had a backlog of them. I was trying to release one every couple months, but life just got away from me and I realized that I was not prioritizing these, and I really enjoy doing these. I have probably about half a dozen that were or are recorded and they're sitting on my hard drive. But when I went back and listened to them, some of them were good, some of them were just not. I didn't like them. I didn't like the way they flowed. I didn't like the way I was't like the way they flowed. I didn't like the way I was communicating stuff. Here's a new one and I hopefully that this one will resonate with some of you Now that I have rebranded the website and my podcast.

Eric: 1:19

For those that are unaware, my new website is thecebecom. So I've rebranded myself from a personal brand, which was Eric Purvis, to a more of a business that is focused on continuing education and continuing education topics. It's not just me, so I'm starting to try to bring in other people to teach relevant content and to kind of expand the offerings to other areas and and other topics and courses that are really really important for those of us in the massage, the manual therapy, the musculoskeletal healthcare world. But people that are teaching topics that are not my area of. I don't know enough. I don't want to say expertise because we're not experts. We're just all trying to be less wrong every day with the things we do. So I hopefully will have some more of those people and their courses coming on board for you in the near future. So that was why I decided to do the rebrand from me to a center for evidence-based education.

Eric: 2:31

Can we actually use the word evidence-based in massage therapy? A lot of people prefer the term evidence-informed and we've had discussions about this before on this podcast, whether it's with myself or with others, about this before on this podcast, whether it's with myself or with others, and I don't want to beat that topic again and again and again. But the stuff that I want to talk about is things that are evidence-based, so things that stand up to scrutiny from research, but also incorporate our own expertise and experiences. And obviously, what's the most important thing is the person that's in front of us. So what's the patient, the client, the person who's coming to seek your care and support Evidence-based for some people think it just needs to be a randomized, controlled trial or systematic reviews, and I'm going to say that when we're talking about evidence-based care, we're talking more about the knowledge that you bring, your understandings of what's happening.

Eric: 3:37

Humans are not able to, we're not able to apply like a linear. I'm going to do this thing to you and you're going to get this outcome. It's not. We don't have these causal cause and effect relationships when we are treating somebody. It just doesn't work that way. I wish it did, because then life would be a lot easier, but things are more complex than that. So we're talking about evidence-based. We're not talking about fixing it. We're not talking about you know, I'm going to do this technique or this intervention to you and you're going to get this predictable outcome.

Eric: 4:11

What we're talking about, we're talking about evidence of the knowledge, and over the last few months, I've really been thinking about this a lot more about the evidence for what it is that we do and how do we use that information into something that speaks to everybody, because I feel that oftentimes, when we are talking about evidence, some people feel it's very dismissive. You know the idea that, oh, there's no evidence for that. I'm going to say say that, yes, in a lot of cases, it can be dismissive if the evidence or the claims that somebody is making are not based on reality. But the evidence that we talk about should be based on our current understanding of how anatomy and physiology works, how touch impacts people, how the clinical encounter impacts people. That's where the evidence, that's where the knowledge base should come from, more so than the techniques, and this is something I've been trying to change and incorporate a lot into the things that I've been doing, which is one reason why I haven't had a podcast in a while. I've just been my brain and my time my bandwidth has been all over the place lately, trying to get all the stuff working together and trying to just figure out what's the direction I want to go with what I do.

Eric: 5:46

Since the start of 2025, I've been busy doing a bunch of other projects, creating some new courses. I did a TMJ webinar, which was my most attended webinar I've ever had, which was wonderful. So thank you for all of you that came to that and supported that. I'm also doing a longer TMJ and headache course. I'm doing one of those in Kelowna in the end of September and that's already sold out. So thank you for again, for everybody that wants to learn from me. I don't think I've ever had a course sell out six months in advance.

Eric: 6:22

So this topic of this TMJ stuff seems to be something people really want to know more about, and what I've been trying to do when I've been creating these courses is going back to the evidence. What is it that we can do that is ethical, is based on best practices and can involve a variety of different approaches? And that's what we find when we're looking at the evidence is that it creates this gray area of uncertainty because we don't really have all of the answers. Uncertainty because we don't really have all of the answers and this is something I'm trying to incorporate into more and more and more of my content is the idea that we don't have all of the answers. And then we're talking about evidence. That actually gives us less answers per se, but it gives us the flexibility to think bigger, and that's the biggest difference that we need to take from the evidence. How many times can I say evidence in one podcast? I don't know.

Eric: 7:36

But speaking of that, you know, I've also realized that when we talk about evidence-based practice, there's a misunderstanding of it, which I know I already said. So what I've decided to do is I do have a webinar coming up this year, which is a webinar. It's an evidence-based practice webinar, so it's about the information and how do we think, how do we reflect, how do we understand and interpret this information? I feel that's an area that's a pain point for a lot of people. They just don't. It becomes confusing and I've tried to take this approach of you know, comforting or allowing people to be okay with that uncertainty without having all of the answers, and to try to simplify what it is that we are doing. You know some of the questions I get and I had this from somebody who attended the TMJ webinar who was asking me all these very biomechanical questions, these very you know, what about this, what about that, what about this muscle, what about that muscle, what about the joint and what about this presentation?

Eric: 8:37

And I really feel that we've spent so much time over complicating things and I don't think that does that works in the best interest of our patients, because we over complicate things and we try to sell a solution. Question we need to ask is what happens if that solution doesn't work? What are they left with? If we tell them that they've got this lateral deviation their jaw swings from one side to the other, or they've got jaw pain and we try to fix it and we can't, and maybe there is some type of structural reason for them, what if someone has ongoing neck pain and we tell them it's their posture, and we tell them they have to sit up in this perfectly aligned posture and that is supposed to be the fix for their neck and their headaches and that doesn't work, then what are they left with? This is why we have to be so aware of the evidence out there, because it doesn't give us these one-size-fits-all solutions. It gives us ideas that are hopefully less wrong and gives us room to explore, gives us room to be curious, to try to do our best to help people.

Eric: 9:59

I think in a lot of my content I've had before I've probably been very dismissive or come across as being more dismissive than I really wanted to or really intended to. But sometimes when we're talking about things, there's just so much out there that is just so incorrect and so full of belief-based systems rather than reality that sometimes I do get a little bit excited about it in a negative way, and I just, you know, I say things that maybe come across as a little bit more firm than they probably should. And I'm not going to go back and change what I said, but I will moving forward and what I'm trying to do is create more room for questioning and for growth and for realizing what the good that we are doing, but also hopefully changing how we think, and by changing how we think we might impact how we do. And if we can do differently, then maybe we can work in a little bit more of an evidence-based way where our communication, our thought processes, the philosophy of why we're doing what we're doing might shift a bit and hopefully what that will do is that will allow us to provide better quality care, more ethical care, care that hopefully meets the needs and expectations better of the person that's in front of us. So for the last four months there's a bit of a ramble there Some of the things that I've been doing.

Eric: 11:33

I've been trying to refocus and kind of repurpose some of the content I have into making it a bit more of this, less, maybe, less certain and more talking about the working within the gray. So, anyway, it's a lot of work, but I'm hoping that it's going to come across in the future webinars that I have and courses that I have this year. The thing that really inspired me, though, about doing this podcast here today was I had seen so much recently, so much recently, online about people selling their courses. I spend a lot of time on social media. I don't really engage as much as I used to, but I do post more. More often than not, I'm posting about, you know, the things that I'm doing. Every now and again I'll engage in some conversations, but I try to. I'm trying to.

Eric: 12:31

I spend more time kind of reading and seeing what's going on out there and in the profession and seeing how, what people are talking about and what kind of things are trending, and the one thing I see all the time is the talk about evidence-based techniques. So what is an evidence-based technique? Kind of drives me a bit crazy, because there is actually no such thing as an evidence-based technique. It sounds like, when people are talking about that, to advertise their courses or to ask questions about what techniques should I do for this? What techniques have the most evidence for working on somebody with low back pain, and this is faulty thinking. This is thinking that needs to really be questioned, because there is no such thing as an evidence-based technique or an evidence-based intervention per se, specifically in manual therapy.

Eric: 13:27

Obviously, if we are talking about medicine, there is evidence-based interventions that you can do where there is a specific problem and you get an intervention and it gives you a predictable solution. You break your arm, you go for surgery, or they reset it, they do surgery, they cast it and it's going to heal. That would be an evidence-based intervention. This is how you fix a broken limb or diabetes. You know diabetes, for example, you take insulin If it's a type 1 diabetic, for example. That would be an evidence-based intervention to fix a specific problem. But in the musculoskeletal world we don't have that. We don't have that specific linear cause and effect idea, unfortunately.

Eric: 14:13

Like I said before, I wish we did, because it sure would make life a lot easier, but people will say that They'll say, oh, I haven't come, take my course, it's full of evidence. You know, we teach evidence-based interventions, and when I read that I think, no, you're, you're missing something, you're. I understand what you're trying to do, because you're trying to say like we're teaching stuff that works and and, but that doesn't mean that the intervention itself is evidence-based. Because what we need to understand and I've probably said this before in this podcast, if not, I know I've said it in others is that we need to understand that all of the interventions that we do when we look at kind of the research about the science of touch and what happens when we put our hands on people, what happens when we massage people, what happens when someone gets a joint mobilization or a high velocity thrust if you're say in chiropractic or physical therapy world the interventions themselves all work via similar or identical mechanisms.

Eric: 15:14

And so I made a post about this. I had one thought one morning, having my coffee, thinking about the world, and I had these thoughts and then, you know, I kind of wrote some of them down and then later on that day, after kind of reflecting on them, I made a post on my Facebook page, my Eric Purvis RMT Facebook page, and it blew up in a good way. There were some great conversations, there were some great comments. It was shared a bunch of times. It was liked 115 times and I had lots of messages sent from people afterwards and I was really, really happy to see it kind of people wanting to. They like the message or they or they had questions about it, comments about it. And I'm just going to read to you what the post was and for those that aren't on social media, that way you can have an idea of what I was thinking and I wrote.

Eric: 16:15

I've never seen anything in massage or manual therapy research discussed about evidence-based techniques. I'm very certain these don't exist. Yet I see people mentioning this all the time on their websites and, in course, advertising. What makes one technique evidence-based and another one not? All techniques probably work via similar mechanisms. Logically, it makes sense that all hands-on approaches are doing the same thing, because it's impossible to bias one tissue over the other, despite widespread beliefs to the contrary. We can't make claims about how one technique is better without plausible explanations. The evidence base is in the knowledge and the reasoning, in how to interact, assess and treatment plan with your patients.

Eric: 16:59

As a profession, I think we would be much further in our professional growth and see more recognition as healthcare providers if we could agree that touch can feel great. There's a wide variety of styles and approaches and none is superior to the other. The goal is to help people feel better, get them back to their activities and increase quality of life. Spending time arguing about what techniques work best and chasing different ideologies feels like an unhelpful use of time. I can relate because I spent a lot of years doing that, gaining a better understanding of different conditions, clinical presentations and the complexities of the pain. Experience shifted my focus away from fixing tissues and towards working with the person in front of me.

Eric: 17:56

That was my post. I had a lot of great comments and a lot of great, great things. I'm not going to read. Read through all of these that were here and if you want to go to my Facebook page and read them, please do. But but this was really. It felt good to put that out there and to get a positive response from people.

Eric: 18:15

Now, obviously, when you put something on your social media page and people that like it or share it or comment on it are probably people that they're biased, right. They follow you for a reason friends or their followers for a reason, and that's something that we need to be very mindful of too, when we are having these kinds of conversations about how we practice, what interventions we like to do, what populations we like to work with, because we will often find ourselves in an echo chamber, in the silo, where we hear what we want to hear, and we're all guilty of that, and we're human. That's just what happens. But the key thing, though, that I feel we need to do, moving forward as a profession, is we need to start having conversations with those that think differently than us, so we can look to see more about what we have in common rather than our differences, because when we start to identify an us versus them mentality, you see exactly what's happening, what happens in the world right now, with these political divisions that are happening not just in the US and in Canada, but across the world, where people identify an us versus them and they see the other person is wrong or the other person is bad. What I think is more helpful is that, if we're talking about evidence-based interventions which evidence-based techniques which I said we don't exist don't exist, but we do know that, regardless of what background you come or what your favorite intervention technique modality is, that you're helping people, otherwise you'd probably not exist making a living. So maybe the framework that you're working under is based on incomplete science, based on pseudoscience. Maybe it is based on reality, but rather than saying hey, but rather than saying hey, you're wrong, you're an idiot. Why don't we look and see what the similarities are? And the similarities are that you're providing touch, you're providing probably some movement, some support, some guidance, a safe place for them to be, and they're feeling better. And maybe, and just maybe, it has little to nothing to do with the specificity or the specifics of your technique. Maybe you could do any other type of technique, maybe you could do the same one and think about it differently or communicate with it differently, and maybe the person would feel just as good.

Eric: 21:07

One thing I've been going on and on about for over a decade now is, you know, a lot of the myth busting, because there's so many myths in this profession that seem to be getting worse. I know I've I've called out the stakeholders in the schools before for saying why do you guys keep teaching this stuff when there's no evidence for it? And they and the the the responses I'll often get is they don't listen to the message they. They hear that I'm criticizing. Therefore they're like we're not gonna talk to you. Oh no, we don't. You know you're, you're, uh, you're not supportive, you know you're, you're against us.

Eric: 21:43

I'm thinking I'm not against you, I'm just trying to say we all have a duty, we all have an ethical obligation to to learn and to change and to adapt. And so if I ask somebody and say well, you know why, why do you say that your technique is the best? Why do you say that you know? Why are you still teaching pseudoscience in your, in your program? Why is the accreditation agents uh, company agency association I can't remember what they're called cmtca, which is important. I think an organization like that needs to to exist to accredit schools. But I wonder, well, why are they accrediting programs that are full of the? Where the?

Eric: 22:34

The curriculum is is full of a lot of make-believe science and belief-based things. It doesn't mean that they're bad. It doesn't mean that what they're doing isn't. It doesn't mean what they're doing is wrong per se. But I just like to have these conversations, I like to ask these questions because I really want people in the profession to think more about the role in advancing this profession and I strongly believe that as long as we keep with these belief-based ideas and these, these ideas about technique specificity and one technique being better than the other, and all these different frameworks of thinking about how our one technique works on fascia and how another technique works on joints and how another technique works on muscles and how another technique works on the nervous system, and you think they all work on all the things, you can't just say that one technique works on one system and that's evidence-based. Another technique works on via another another system. It doesn't work that way. They work on all the things because this touch, you're putting your hands on the skin and you're pushing, pulling, twisting and there's going to be impacts on all the tissues and functions that through through that touch.

Eric: 23:57

So I really feel that we are spending a lot of time in school and in continuing education focusing on the wrong things. Yes, we need to know, we need to learn a variety of different ways of styles of touch so that way you can be comfortable working in different regions of the body. Try different things that work best for you and for the people that come to see you. That's fantastic. Maybe sometimes you're doing kind of Swedish flowing techniques, because those just feel amazing. Maybe sometimes you're doing kind of a slower, slower stretching into the tissue. Maybe sometimes you're doing more slow holes. Maybe sometimes you're doing more poking, more like point specific stuff. Maybe sometimes you do more broad stuff. Maybe sometimes you're doing some contract relax, some movements, some active or assisted stretching. There's a variety of different ways that you can work with somebody and I think it's important for us in school and in the continuing education world to do all those things, to try all those things to see, so we become comfortable in it and see what works with someone and what might not work.

Eric: 25:12

And we all develop our own style. We all develop our own approach that is unique to us, and oftentimes what we do is we just take a blend of a bunch of the different things that we've learned over our careers and turn it into our own approach, and I think that's great. But let's stop focusing on learning and collecting all these different techniques and these modality empires and let's start having conversations about what is similar. How can we take these approaches and not focus on evidence-based techniques and focus more of our energy on learning about understanding the complexity of pain, understanding how to be better at communicating, understanding, being better at treatment planning, at assessing, at really getting a better understanding of clinical presentations and what's it mean if somebody presents with shoulder pain and it's they have trouble abducting, you know, past, say, 45 degrees and they've got pain and they are of a certain age and they whatever we could just go on and on about you know different presentations and and understand, like, the risk factors and and the presentations for for something, so that way we could say we could have a better understanding of what like, say, a rotator cuff problem versus a frozen shoulder potential.

Eric: 26:53

Or we're looking at back pain. Is this more of a disc or is it a radiculopathy pain? Is this more of a disc or is it a radiculopathy? Is it just a we don't know like a non-specific back thing? Do we need to often try to search and find the thing that is causing it? Because we know we can't. But maybe what we should do is, rather than searching for these quick fixes and providing this evidence-based technique, we could learn to say, hey, let's recognize the pain that this person is in, let's recognize their functional limitations and let's try a variety of different things with our hands and with movement and with support and with guidance to try to help that person to feel better, with support and with guidance to try to help that person to feel better.

Eric: 27:47

It's a shift, I think, in how we need to think as a profession, how the MSK professions altogether need to think. But I'm quite comfortable in saying, in using the evidence that's out there. So, looking at, you know, all the research evidence that's out there, both quantitative and qualitative, as well as kind of, you know, hypothetical, theoretical, as well as 20 years of clinical experience, which I have now and having worked with I don't know how many patients in my career thousands maybe to say that the approach that I advocate for is definitely less wrong than the status quo approach. Way of thinking we need to change. I think, when we look at how we're putting curriculums, education together and licensing new therapists, I think that we aren't doing as best as we could. Some places are, some places are not. So this is not saying everyone's doing terrible. This is not an all or nothing thing.

Eric: 29:06

I think the continuing education world would be better served by focusing more on working with specific populations or areas of interest rather than just trying to teach techniques. That's something that was my main reason why I put my course creators group which I do every year I've been three years now with that and it's gone really well is to try to help people to put course content together that is different from the status quo, that focuses on the things that matter most, not learning another thing. So, in summary, what we do as a profession is great, has huge value, but it can still be better and the things that we focus on so often in our social media conversations and the courses that are out there, I feel are not always focusing on the things that matter most, which is critical thinking or understanding and knowledge of the evidence about specific regions or patient presentations, and focusing on working with the uncertainty about what works and what doesn't work, because we don't know. There is no one-size-fits-all treatment, there is no one-size-fits-all pain management. It's whatever works best for the person in front of you that day, that time, and what works one day for that person might not work for them the next, and that's okay.

Eric: 30:51

That evidence-based practice teaches us to be flexible. The techniques we do, they all work via the same way. As far as we know, none is better than the other, but they all help. Let's have those conversations moving forward rather than us versus them. Let's focus on the similarities and how can we work together rather than pushing each other away. So thanks for listening. I hope you enjoyed this episode and I will try and get another one out within the next four months. Have a good day.